Gait Analysis & Carbon Fiber Bracing

Last week I read two different articles that, when read together, had a really big impact on me. So I thought I would share what I learned in a post.

The first article, which I had read before, and is linked here on the site is about a Feldenkrais practitioner who used a gait analysis to help a woman improve her walking skills. Jan, the woman in the article has a cervical lesion level and has spent her entire life refusing to take no for an answer. She has beaten the odds at every turn and has taken advantage of every available doctor and therapy to help her walk, keep walking and walk better.

The idea of having one’s gait analyzed for the purpose of improving it – making it more natural, easier to perform and lessening the overall impact on one’s frame – is fascinating to me.

The article described the gait analysis process as follows, “Gait analysis provides an enormous amount of descriptive information. . . Details about muscle activation patterns, forces as the foot hits the ground, angles at joints, spatial and timing relationships between different body parts, sources of power (what parts help propel or slow you down), and more become apparent with the aid of special cameras, electromyography (EMG), and force plates.”

The gait analysis results were as follows, “After the research team evaluated all of the data from Jan’s testing, we agreed that we wanted to try to improve her walking strategy and reduce her risk of falls. Jan walked stiffly, tended to drag her right toe, and kept parts of herself locked together (sort of like a gunslinger in an old western movie). We wanted to help Jan learn to differentiate her movements, use more trunk rotation, involve her legs more effectively, and also improve her balance.”

The rest of the article goes on to describe the types of exercises they worked on and how they improved her movement. They used the following adjectives to describe her improvements – smooth, fluid, elegant and even “lazy.”

The second article was even more interesting because it was all new information for me. A few weeks ago, someone over on the Baby Center board posted about carbon fiber braces and gave a link to PhatBraces.com. I visited the link, watched the videos and found it all very interesting. I discussed them with our orthotist, who has a carbon fiber prosthetic leg, and he was very supportive of the idea. Then Camilla told me that she thought carbon fiber was contraindicated for clubfeet. I asked for her source and she sent me this fascinating article about the benefits of carbon fiber bracing (which did list tight Achilles tendons as contraindicated).

What makes the article so fascinating is that it discusses a change in thinking about orthotics. I tried to include some quotes from the first page, but ended up quoting almost the whole thing. So that’s what I’m going to do. Here’s the first page:

Clinicians are gathering data, both anecdotally and through studies, that elucidate the advantages of using carbon-fiber ankle-foot orthoses (AFOs) to manage foot drop instead of the more traditional plastic posterior supports that cross the heel. It’s been known for a while that carbon-fiber AFOs provide energy return at toe-off; what’s increasingly intriguing is evidence that the devices allow the calf muscles to fire, preventing atrophy and often allowing muscle tissue to regenerate.

“This use of carbon is a paradigm shift in the orthotic industry,” said Carey Jinright, CO, of Precision Medical Solutions in Montgomery, AL. “We’re going from creating static alignment to creating a functional environment.”

Jinright explained that plastic posterior longitudinal supports (PLSs) were never intended to provide energy return or help normalize gait.

“As clinicians, we became very narrowly focused,” Jinright said. “We saw the patient dragging their toes during swing phase and thought, for safety reasons, that we wanted those toes to clear the floor. The problem was that if you do that with static alignment, what happens at heel strike? The patient is locked into a 90-degree position, and a lot of times they overcome that fixated angle through excessive flexion of the knee.”

“If the patient can achieve controlled motion, why would we want to take that away? Our goal should be to control excessive motion—pronation or supination—not the useful motion they already have,” he said.

According to Randy Stevens, BOCPD, CFO, who practices in Harrisburg, PA, patients wearing plastic posterior AFOs sometimes demonstrate recognizable gait patterns that practitioners can take as a cue for a different type of intervention. “You’ll often see a little more hip hike, then not as much toe off at the end of the gait cycle,” he said. “The energy restoring aspect of carbon AFOs increases range of motion in the knee and hip, and leads to less abducted gait patterns. More muscles are firing, so we’re not contributing to weakening of the gastrocs. Oftentimes a more normal gait brings with it a more erect posture, as well.”

It’s a 6 page article and well worth the read. Over the remaining pages, it goes on to say that carbon fiber AFOs have been shown to increase walking speed, decrease energy cost, create stronger muscles, improve stride length, increase energy return, provide larger range of motion and a allow for a more physiologic gait.

As I read and reread the articles, I wondered how many people could benefit from these types of gait and bracing analyses. How many lives could be changed if more physical therapists, orthopedics and orthotists refused to be content with the status quo, and were always looking for ways to improve and innovate? I’m not here to blame anyone. I really just want to help people. I get SO excited about new ideas and I get SO frustrated with those who refuse to even consider them.

Throughout our Spina Bifida journey, we’ve refused to listen to the old school, that’s just the way it is, because that’s the way we’ve always done it people. And we’ve searched high and low for the out of the box, there’s got to be a better way, we can figure this out innovators. And I’m still looking for more of them, for sure!

The gait analysis article said that they decided to turn Jan’s analysis into an official study “because little is known about the gait of adults with Spina Bifida (most become users of wheelchairs).”

I’ve been told that those who walk as children, but convert to a wheelchair as adults, do so because of pain and fatigue. Well what if better physical therapy techniques and improved orthotics could change that?

One comment

My DD had a gait analysis last month. Check out the Motion Analysis Center at the Rehabilitation Institute of Chicago (MAC at RIC) and Drs. Dias and Swaroop. Best in the world for ped ortho and SB from what I understand. The gait analyses provided a LOT of information in conjunction with a manual muscle test, esp since my DD has an imbalanced pattern of function in her ankels and feet. They did the gait analysis prior to preparing their surgical plan. Super easy test for the kids. We did have to appeal to the insurance company three times to get it covered however.

Regarding the carbon fiber braces, we had an orthotist as a speaker at our local ISBA chapter meeting recently. He seemed very up to date on the latest and greatest in bracing, and mentioned carbon fiber braces. I will admit I wasn’t paying the best attention as bracing doesn’t apply to us just yet. But anyway, the gist of his talk was that carbon fiber is up and coming but still not perfectly tweaked for the SB community and plastic is still where it’s at. There was some drawback that made sense at the time, but I have forgotten what it was. So keep pursuing it and forcing them to experiment!!

Bladder Continence

SPINA BIFIDA CHILD

“I GIVE THE MACE PROCEDURE 5STARS. MY GRANDCHILD HAS HAD THIS SINCE HE WAS ABOUT 2YRS OLD AND HE IS 10NOW. HE HAS NEVER HAD ANY BAD EXPERIENCE. WE FLUSH HIM EVERY OTHER NIGHT AND THIS KEEPS HIM CLEANED OUT; HE DOESN'T HAVE ACCIDENTS ON HIMSELF AND HE GOES TO SCHOOL AND IS JUST LIKE EVERY OTHER CHILD. THEY SEE NO DIFFERENCE IN HIM AND HE HAS NEVER HAD TO BE EMBARACED ABOUT SMELLING OR USING THE BATHROOM ON HIMSELF. THIS IS A SCHEDULE THAT WE STICK TO, THIS HAS BEEN THE BEST THING FOR THE WHOLE FAMILY!!! LOVE IT !!!!!”

Molasses are magic

“My baby was on Miralax from 4 months to 10 months old. Despite being entirely breastfed, she became constipated within days of starting Ditropan for her bladder. I hated having to give her the Miralax and never even achieved very good results. I heard about using emulsified fish oils and blackstrap molasses as an alternative. I have to admit that I was skeptical at first. I started with just the fish oils, which did make the stools very slippery but not soft enough. I then added the molasses - wow, magic!! The stools are now the perfect consistency, much better than I could ever achieve with Miralax. And we have the added health benefits of fish oils (heart and joint health, brain health, etc) and molasses (great source of iron that won't cause constipation). The only reason for 4 stars instead of 5 is that my baby initially was not a fan of the flavors and it takes a bit to find the perfect dose. However, I am finding easier ways to get the supplements in and flavored fish oils help too. We are also able to mix her daily probiotic right in with these supplements to really round out her bowel health.”

Diaper cream and cloth diapers

“I swear by cloth diapers. Not only does it greatly reduce the incidence of diaper rash, but also help reduce waste and reduce cost. Cloth diapering these days is very, very simple - no more diaper pins and folding! Seriously soooooo easy! When there is diaper rash, you can still use diaper creams, but have to be careful to not get the creams onto the diaper (some of them can damage the wicking/drying ability of the diaper). I just put a single Via paper towel between the diaper and baby to protect the diaper when using creams. My LO recently had a fungal diaper rash after being on mega antibiotics for a presumptive UTI. My favorite cream to use was a mixture of Critic-Aid (by Coloplast), any OTC anti-yeast cream (like Vagisil), and hydrocortisone. I hated using medicated ointment, but it cleared the rash up quickly, so I could go right back to plain cloth diapers without the paper towel and only natural creams when needed.”

- Tracy

Water therapy in all forms is amazing!

“My 11 year old with SB is a mermaid! She is the first one in the pool or lake and the last one out of our 5 kids. She tells me she feels "lighter" in the water and "more mobile." I have noticed that after our aquatic therapy sessions or a week at the lake, she is much more confident, mobile, and generally in better health. I highly recommend finding a therapist who is willing to work in water or find a swim instructor who has experience with special-needs kids.”

- Lydia Wells

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